Choosing Medicare Part D: Medicare Prescription Drug Plan Costs

A1. The most popular ways to lower drug costs include: (a) looking for generic alternative drugs, (b) consider mail order pharmacies, (c) check if you may be qualified for Pharmaceutical Assistance Programs, such as PACE/PACENET in Pennsylvania (see Q5), (d) use low cost Generic Drug Programs (see Q6)

Q2. Are brand-name drugs superior to generic drugs?

A2. This is a very popular misconception. The generic drugs are interchangeable with brand-name drugs. They appear on the market once the patent of the original drug manufacturer has expired. They are less expensive because they do not need to cover the original drug manufacturer’s expenses for research, development, promotion and advertising.

Q3. I have prescribed a lot of generic drugs. What plan should I look for?

A3. Look for the tier-based plan that will charge you nothing or lower copayments for generic prescriptions.

Q4. I have very few drug prescriptions. What plan should I look for?

A4. Look for a plan with zero or low monthly premiums. You may consider changing your plan in the future when you’ll use more drug prescriptions.

Q5. What are other Prescription Drug Coverage Options?

A5. It depends on the state in which you reside. For example, in Pennsylvania there is PACE/PACENET prescription plan – a state prescription plan for Pennsylvania residents age 65 and above who meet eligibility requirements. There are also other programs: TRICARE, Veteran’s benefits, etc.

Q6. What are low cost Generic Drug Programs?

A6. Many chain stores and grocery store pharmacies (Wal-Mart, Target, Costco, etc.) are offering the most commonly used generic drugs at very low cost. Anybody can participate in these programs.

A8. Once selected, most Medicare beneficiaries do not want to change their Medicare Plan D plan from one year to the next. However, there is a high probability that the plan that was optimal this year will have substantially larger costs the following year. Each Medicare Prescription Drug plan is required to provide to its members the Annual Notice of Change by September 30. This includes both changes in benefits and costs. Therefore, review the plan changes and if you’re ready to change the plan, do it at the Annual Enrollment Period (October 15 – December 7). The coverage will begin January 1 of the following year. Remember:

Compare benefits and costs of your present plan with those of other plans.

If you’re ready to make a change, sign up as soon as possible. It’ll help you to guarantee the uninterrupted coverage.

A10. Enroll in a drug ‘enhanced plan’. It’ll provide you some coverage during the gap (such as generic drugs), usually for an extra premium.

Q11. Are there any exceptions from the Coverage Gap?

A11. Yes, people with limited income and resources who qualify for Extra Help are NOT affected by the coverage gap. They will continue to pay the same copayment.

Q12. Should I use Medicare Part D plan card during the donut hole?

A12. Always use your Medicare Part D plan card, even during the donut hole. It’ll allow you to buy the prescription drugs at the plan’s negotiated prices, and to track and calculate your out-of-pocket costs automatically.

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